Individual
JERRY DEAN POWELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.MIN.
Contact information
Practice address
916 ARSENAL AVE, FAYETTEVILLE, NC 28305-5328
(910) 309-1574
(910) 323-0310
Mailing address
7429 WILKINS DR, FAYETTEVILLE, NC 28311-9434
(910) 309-1574
(910) 323-0310
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3565
NC
106H00000X
Marriage & Family Therapist
1207
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
199121
MEDCOST
NC
05
—
6103661
—
NC
Enumeration date
10/04/2006
Last updated
06/15/2012
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